690360.pdfPOSTED ON KROLL MAP NO.:
PERMIT
NUMBER
BUILDIN6 DEPARTMENT Applicant Fill 690360
Inside Heavy Linel; JOB ADDRESS
PERMIT APPLICATION I
., OF ..jBIN 0
N>.Irfi (Olt NA
SETBACK STREET SETBACK
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USE ZONE LOT "JUA
VACANT SITE
If
0 0
NUMBER
YES
T PHONE
0
17*7k, fz:27
Ti—EIGHT ijullDING AREA
VAIRUIANCE MBER
0 ?7 e15
NAME
PLOT PLAN APPROVED
14
ADDRESS
F4
STREET RIW
—TELEPHONE
EXISTING STREET R/W ........... YT. DEFICIENCY THIB PROPERTY
9
MTV
1 NUMBER
1
COMP. PLAN ST. R/W ............ FT.
............
1
REMARKS
NAME
e
03
ADDRESS
CHECKED BY
CITY
TELEPHONE NUMBER
F4
A
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMUNA
9d
—Attach
—RE—MARKS
Legal Description Of Property (Show Below or Four Copies)
m�vW nnNWIrCTIGN I VERIFIED BY
I
C I �
NEW
ADD
ElALTER
REPAIR
RESIDENTIAL 10
12 �NON-RES�IDENTIALJ
El
GAS
LJNE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
DDEMOLISH
EXCAVATE
D OR FILL
PRE -MOVE
INSP.
;UMBER OF STORIES
_T_
NUMBER OF
DWELLING
UNITS
IWO
C] YES
[I YES 13 NO
[3 NO
-4)
1A)SPEC710A)
NATURE N
— �Pr ORK TO BE 0 1.3
dd
Valuation
Fee
6 _Xlrt -e S -el
Fla, Check No ................. ...
V
BUILDING
Zd24Q.
5�', 6 6.
7]?RO BED USE:
PLUMBING
P
PLOT PLAD[-$9ndIcz,t8 Building actDowns, abutting streets) V
BE AT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PnE-MOVE INSPECTION
L�XCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formatton given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TIUS PEIMT
This application Is not a perfnit until
ralallng to WorkaneWs Compensation Insurance.
AUTHORIZES
signed by the Building official or his Dep-
NOTE: Permit Cimit one Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
Imowledged in Space provided.
plated In six months.)
--giffiNd RE (OWI4EI0 AGE T) DATE SIGNE
INSPECTION
DIRECTOR'
( C�
DEPARTMENT
CITY OF
ice
EDIVIONDS
DATE
9
NOTE: Apfificant Subjec<fo Play, (6eck
PR 6.1107
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
murqueeg, etc.) will require &eparate permission.